Goo Yang
Goo presented with swelling of the right mandible and an unerupted tooth, indicating a potential underlying issue that required further investigation.
Overview & causes
Jaw fractures in pets often result from trauma and require specialised care. Our focus is on preserving function and anatomy in these cases.
The oral cavity’s high vascularity aids in fracture healing, provided the fixation is reasonable.
However, even with the bones repairing and healing back together, return to function is not guaranteed. Successful treatment not only relies on the repair and healing of the fracture but also on restoring normal and functional occlusion.
Common causes of jaw fractures in pets include traumatic events such as falls or accidents, inter-dog aggression, dental extractions (especially in older animals) and other external forces resulting in unforeseen damage.
Challenges & Factors
Oral fractures present challenges due to bacterial contamination, difficult access and periodontal disease. Repair centres on preserving oral function, preserving teeth and ensuring proper occlusion.
Immediate relief involves temporary stabilisation, usually with a muzzle. A comprehensive clinical assessment follows to determine the extent of the damage, always requiring dental X-rays and often a CT scan for full evaluation.
Specialised care is crucial for animals with complex health conditions affecting anaesthesia risks.
Many patients with jaw fractures have also suffered other trauma, especially to the head, making their care complex. Some require stabilisation of more severe injuries before attempting jaw fracture repair.
Types of jaw fractures & repair considerations
Maxillary fractures are usually less frequent, and conservative treatment is possible. If the maxillary fractures are not significantly displaced, the surrounding tissues can often stabilise these fragments well.
Surgical closure of any soft tissue injuries will greatly enhance stabilisation. Severe cases may require interdental wires and acrylic splints.
Mandibular fractures are common in companion animals.
There are several points to consider in selecting a repair method:
- The dental arcade is the tension side of the fracture
- The final occlusion is the most important factor in fixation
- Mandibular tooth roots go virtually to the ventral border of the mandible and are unlikely to be missed with fixation devices
- Any damage to the teeth during repair will cause long-term complications
- The maxillary teeth occlude to the outside of the mandibular teeth
What we do -Repair techniques
Successful repairs often use interdental wiring techniques combined with acrylic splints, with variations based on fracture type and position.
Cerclage wiring for symphyseal separation
Symphyseal separation is common in cats and may be associated with TMJ luxation or caudal mandibular fractures. Cerclage material placed behind the canine teeth is the best technique for uncomplicated separations. This has traditionally been performed with wire. However, modern synthetic sutures are suitable and, in many cases, superior to wire. Complete, firm stabilisation is not necessary.
Figure of 8 wires around the canines disrupts occlusion, making inter-canine bonding a better choice for complicated separations.
Interosseous wiring
Wires can be placed to stabilise the fracture providing care is taken to avoid dental damage. Radiographs are taken with markers in place to ensure that tooth roots are avoided, and small holes are made with drills or small pins for the wire placement.
Interdental wiring
This involves placing wires around adjacent or multiple teeth to stabilise the fracture. The wires are placed below the enamel bulge of the tooth (at the gum margin) to prevent them from slipping off. If this is unsuccessful, a small amount of composite resin is placed to hold the wire, or a small notch can be made in the tooth.
There are several wiring techniques, but they all involve tightening a series of loops around the teeth, which then act as a fixation device. An acrylic splint is often used over this wire to increase the effect.
Inter-canine bonding
This is a very useful technique for multiple unstable fractures, especially those involving the caudal mandible of cats.
What we do Post-operative care
After surgery, it’s crucial to maintain oral hygiene due to the rapid accumulation of bacteria in the mouth. This risk increases around intra-oral appliances, potentially leading to tissue infection. Regular mouth rinsing and eating foods that leave minimal residue are essential.
Most patients with jaw fractures recover well and usually resume normal activities within about 6 weeks of healing. While the recovery period may be challenging for some, the majority regain normal interaction with their families and resume eating and drinking normally. Ensuring continued monitoring and following post-operative care instructions diligently contribute to successful outcomes.
